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<meta name="description" content="一、体位的重要性。在牙科操作中有害的人体工程学习惯为：①错误的临床姿势；②静态的操作姿势；③用力；④重复运动。对关节来说，自然姿势是当关节在其运动范围的中间部分使用时的姿势。离这个状态越远，关节肌肉越紧绷。静态姿势是使身体长时间保持一个姿势。（我觉得记住这个原则就行了，其它的，在实操中注意让自己的体位不违反这个原则，基本就是正确的了。）重复运动指在一个工作循环中需要重复进行超过50%的同一个基本动">
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<meta property="og:description" content="一、体位的重要性。在牙科操作中有害的人体工程学习惯为：①错误的临床姿势；②静态的操作姿势；③用力；④重复运动。对关节来说，自然姿势是当关节在其运动范围的中间部分使用时的姿势。离这个状态越远，关节肌肉越紧绷。静态姿势是使身体长时间保持一个姿势。（我觉得记住这个原则就行了，其它的，在实操中注意让自己的体位不违反这个原则，基本就是正确的了。）重复运动指在一个工作循环中需要重复进行超过50%的同一个基本动">
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          <h1 class="post-title" itemprop="name headline">牙周治疗的体位</h1>
        

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        <p>一、体位的重要性。<br>在牙科操作中有害的人体工程学习惯为：①错误的临床姿势；②静态的操作姿势；③用力；④重复运动。<br>对关节来说，自然姿势是当关节在其运动范围的中间部分使用时的姿势。离这个状态越远，关节肌肉越紧绷。<br>静态姿势是使身体长时间保持一个姿势。（我觉得记住这个原则就行了，其它的，在实操中注意让自己的体位不违反这个原则，基本就是正确的了。）<br>重复运动指在一个工作循环中需要重复进行超过50%的同一个基本动作。<br>牙医常碰到的肌肉骨骼问题<br>①胸廓出口综合症(Thoracic Outlet Syndrome)<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0091-yzzltw/01.png"><br>②肩部肌腱炎(Rotator Cuf Tendinitis）<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0091-yzzltw/02.png"><br>③旋前肌综合征(Pronator Syndrome)<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0091-yzzltw/03.png"><br>④伸肌紧绷(Extensor Wad Strain)<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0091-yzzltw/04.png"><br>⑤腕管综合征(Carpal Tunnel Syndrome, CTS)<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0091-yzzltw/05.png"><br>⑥尺骨神经Entrapment（Ulnar Nerve Entrapment)<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0091-yzzltw/06.png"><br>⑦腱鞘炎(Tenosynovitis)<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0091-yzzltw/07.png"><br>⑧肌腱炎<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0091-yzzltw/08.png"><br>二、医生坐姿<br>自然体位<br>A.脊柱基础：健康后背的弯曲。<br>①脊柱由3部分构成：颈部、胸部和腰部。<br>②脊柱有3个自然弯曲，形成一个S形。当这三个自然弯曲被良好的对齐时，耳朵，肩膀以及臀部在一条直线上。<br>a.当从侧面看时，颈部和腰部在直线的内侧（脊柱前）。<br>b.当从侧面看时，胸段在直线的外侧（脊柱后）。<br>B.医生的自然体位。<br>①颈部自然位置(Neutral Neck Position)<br>目标：<br>a.头的倾斜范围:0°-20°。<br>b.从眼睛到治疗区域的连线尽量的接近垂直。<br>避免：<br>a.头部过度前倾。<br>b.头偏向某一侧。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0091-yzzltw/09.png"><br>②背部自然位置<br>目标：<br>a.从臀部起向前轻微倾斜(以臀部为旋转点）<br>b.躯干（Trunk）弯曲0-20°。<br>避免：<br>过度弯曲脊柱(后背弯曲）<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0091-yzzltw/10.png"><br>③躯干自然位置(Neutral Torso Position)<br>目标：躯干与身体长轴在一条直线上。<br>避免：<br>a.躯干向一侧倾斜。<br>b.扭转躯干。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0091-yzzltw/11.png"><br>④肩部自然位置<br>目标：<br>a.双肩在水平线上。<br>b.坐着时双肩平均负担重量。<br>避免：<br>a.耸肩靠近耳朵。<br>b.双肩缩成一团。<br>c.坐着时重量放在臀部。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0091-yzzltw/12.png"><br>⑤上臂自然位置<br>目标：<br>a.上臂与躯干长轴平行。<br>b.手抬起时肘部与腕部在同一水平线，稍微远离身体。<br>避免：<br>a.肘部离开身体超过20°。<br>b.肘部高于腕部水平。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0091-yzzltw/13.png"><br>⑥前臂自然位置<br>目标<br>a.与地板平行。<br>b.如果需要抬伸和放下，绕着轴关节旋转（意思是腕关节不动）。<br>避免<br>前臂和上臂之间的角度要小于60°（即抬起不超过30°）。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0091-yzzltw/14.png"><br>⑦手的自然位置<br>目标：<br>a.小指一侧的手掌稍微低于拇指一端的手掌。<br>b.腕关节与前臂平齐。<br>避免：<br>a.拇指一端的手掌向下，手掌与地面平行。<br>b.手和腕向上或向下弯。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0091-yzzltw/15.png"><br>一个技巧：可以用一根带子来检查是否坐到了合适的位置。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0091-yzzltw/16.png"><br>正确的坐姿<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0091-yzzltw/17.png"><br>不正确的坐姿：双腿并拢或者搭在一起。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0091-yzzltw/18.png"><br>三、患者的位置<br>仰卧或半仰卧患者位置：牙科治疗时建议的患者位置是患者背靠在牙椅上。对于上颌治疗，在仰卧位时牙医接近与地面平行。对于下颌的治疗，牙椅后背轻微垂直形成半仰卧位（semi-supine position)。<br>治疗上颌时的患者体位<br>身体：患者的脚应该与其鼻尖平齐或者稍微高一些。<br>椅背：椅背应该与地板接近平行。<br>头部：患者头顶应该与头靠的上缘平齐。如果需要，请患者滑动身体以达到这个位置。<br>头靠：调整头靠的位置，使得患者头部在个向上抬的位置，使其鼻子与颏部平齐。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0091-yzzltw/19.png"><br>治疗下颌时的患者体位<br>身体：患者的脚应该与其鼻尖平齐或者稍微高一些。<br>椅背：椅背应该比平行位置稍微抬高，与地板呈15°-20°角。<br>头部：患者头顶应该与头靠的上缘平齐。如果需要，请患者滑动身体以达到这个位置。<br>头靠：抬高头靠，使得患者的头位于一个颏部向下的位置，使其颏部低于鼻部。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0091-yzzltw/20.png"><br>四、灯光的位置、器械的位置<br>理想情况下，牙椅灯的放置要使得光线能与地面近似垂直。<br>对于下颌牙齿的治疗，灯的放置使光线与地板近似垂直。<br>对于上颌，常难以达到理想的光线要求。常需要将灯光移动到患者颈部上方，成一定角度摄入口腔。重要的是要知道顶灯放置远离自己的视线（围绕在患者的腕部）有助于降低后背疼痛。<br>把灯放置在距离自己一臂远的地方，避免把灯放置在患者头上。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0091-yzzltw/21.png"><br>器械托盘的位置：应该放置在医生的手能轻易到达的地方。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0091-yzzltw/22.png"><br>五、钟表体位<br>把患者头部想象成一个钟表，头部方向是12点，脚部方向是6点。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0091-yzzltw/23.png"><br>8点钟体位：<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0091-yzzltw/24.png"><br>9点钟体位：<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0091-yzzltw/25.png"><br>10-11点钟体位：<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0091-yzzltw/26.png"><br>12点钟体位：<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0091-yzzltw/27.png"><br>1-2点钟体位：<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0091-yzzltw/28.png"><br>具体治疗牙位与体位：<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0091-yzzltw/29.png"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0091-yzzltw/30.png"><br>后牙，靠近医生一侧是在9点钟，远离医生一侧是在10-11点钟方向。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0091-yzzltw/31.png"><br>六、建立正确体位的顺序：<br>避免疲劳和损伤的一个主要内容就是合理放置患者和器械以适应于医生的体位。<br>在工作时，医生必须能获得进入患者口腔的通道，并且没有任何弯曲，拉伸，或将其肘部抬高至高于腕肘平面。<br>首先建立自然坐位，然后其他一切——牙椅，患者的头部，牙椅灯，以及其它牙科设备——都来适应于保持术者的自然坐位。<br>①按正确的自然体位坐下，靠近患者，前臂交叉在腕部水平，而不是中腹部。<br>②将牙椅放到至治疗位置（上颌：仰卧位，下颌：半仰卧位）。<br>③根据治疗区域放置患者头部（上颌：抬颏位，下颌，降颏位）。<br>④患者张开的口腔应该低于医生的肘部。<br>⑤在这个位置，医生将不必抬起其肘部就可以达到治疗位置。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0091-yzzltw/32.png"><br>（注：这是打算在单位晨会上分享的总结，ppt上放图，文字精简一点就OK啦。）<br>我发文章的三个地方，欢迎大家在朋友圈等地方分享，欢迎点“在看”。<br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的知乎文章地址： <a target="_blank" rel="noopener" href="https://www.zhihu.com/people/zhao-you-min/posts">https://www.zhihu.com/people/zhao-you-min/posts</a><br>我的微信个人订阅号：赵瑜敏的口腔医学学习园地</p>
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